DIMENSIONAL CHANGES OF BUCCAL BONE AFTER IMMEDIATE IMPLANTATION USING DIFFERENT GRAFTING MATERIALS: A SYSTEMATIC REVIEW
Jonas Zigmantavičius1*, Gerda Kilinskaitė2, Marijus Leketas1
1Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania. [email protected]
2Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
ABSTRACT
The purpose of the systematic review is to evaluate the influence of different grafting materials on buccal bone resorption after immediate implantation. A systematic review of the literature was performed according to the PRISMA guidelines in search of clinical trials published between 2017 and 2022. The research was conducted in electronic databases, including PubMed Medline, Wiley Online Library, The Cochrane Library, and references of relevant studies. In total, 10 studies were included in the systematic review. Seven of included studies are randomized clinical trials, and 3 are described as cohort studies. Considering all involved studies with various grafting materials, the slightest buccal bone reduction after 3 months in vertical dimension was achieved using PRP material (the change of buccal bone reduction 0.03 ± 0.08 mm). After 4-6 months, the greatest results in the horizontal dimension were achieved by using the no grafting technique (0.1 ± 0.6 mm) and in the vertical dimension by using PRP material (0.07 ± 0.10 mm). After 9-12 months, the lowest bone resorption in vertical buccal bone was reached by using PRF material (0.7 ± 0.5 mm). Biomaterials (PRP and PRF) have favorable results in buccal bone resorption prevention after applying in jump space during immediate dental implantation.
Key words: Immediate implantation, Jump gap, Jump space, Grafting.
Introduction
After the loss of teeth, inevitable bone remodeling processes of the alveolar ridge begin [1]. The maximum bone resorption is observed in the first 3 – 6 months after tooth loss [1-4]. Although it slows down later, after 6 months, 29% – 63% of bone width and 11% – 22% of bone height are lost [1]. If no treatment is performed to restore extracted teeth, up to 40 – 60% of bone volume is lost after 3 years [5, 6]. Generally, greater bone loss is more likely on the buccal side than on the lingual side [7].
After losing a tooth, aesthetic, masticatory, and speech functions could be impaired. To restore the tooth as soon as possible and preserve alveolar bone resorption, immediate implantation is suggested [8, 9].
One undesirable occurrence of immediate implantation is residual space between the implant and the socket wall, called the jumping gap, which may lead to bone loss and implant stability reduction. Beneficial to sustain the appropriate volume of alveolar bone after tooth removal with immediate implantation and reduce resorption, the jumping gap could be filled with different materials. Biomaterials, including xenograft, alloplastic graft materials, and platelet concentrates in preserving alveolar ridge have already become common clinical practice and can considerably reduce postoperative alveolar bone resorption [10]. Xenografts have been shown to exhibit excellent properties: biocompatibility, osteoconductivity, slow resorption rate, and maintaining augmented bone volume [11]. Alloplastic grafts are also appropriate materials stimulating osteoconductivity and are particularly effective for bone grafting [12]. Different platelet concentrates have become popular substances as alternatives to prevent significant bone resorption [13]. Platelet concentrates have demonstrated the ability to improve soft tissue healing after surgical procedures [14, 15]. Nonetheless, there is still controversy about hard tissue healing using platelet concentrates [16].
The purpose of the present systematic review is to evaluate vertical and horizontal changes of buccal bone following immediate implantation and identify different grafting material's influence on the buccal bone resorption.
Materials and Methods
Protocol and registration
Systematic review aimed to evaluate the influence of different graft materials in reducing alveolar ridge buccal wall dimensions after immediate dental implantation.
Electronic databases were searched for clinical studies evaluating the vertical and horizontal change of the buccal wall of the alveolar ridge after immediate dental implantation with jumping gap grafting using different materials.
A systematic review was performed in accordance with the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) [17]. The systematic review protocol was documented in advance. The protocol for the review was registered prospectively in the PROSPERO, registration number: CRD42022360891.
Focus question
The focused clinical question development according to the PICO criteria for the present review:
Which grafting material causes the least vertical and horizontal buccal bone reduction after immediate dental implantation?
Search strategy
The research was conducted independently by two reviewers in electronic databases, including PubMed Medline, Wiley Online Library, The Cochrane Library, and references of relevant studies from March 21 to May 27, 2022. Databases were searched using the following query: ((immediate) AND (implantation) AND (graft OR grafting OR platelet) AND (buccal OR labial OR alveolar) AND (dimension OR vertical OR horizontal OR width OR jump OR space OR gap) AND (reduction OR change) AND (bone)).
Study selection
In the studies, a dental implant should be implanted into the socket of the recently extracted tooth, and the jumping space between the implant and the buccal bone wall should be grafted with different grafting materials. Vertical and horizontal changes in the reduction of buccal wall dimensions should be assessed by radiographic examination.
Clinical studies with humans, published less than 5 years ago (from 2017 to 2022), written in English, and identifying changes in the reduction of alveolar ridge buccal bone were analyzed in this systematic review. All meta-analyses, systematic and narrative reviews, letters to the editor, case reports or case series, animal and in vitro studies, or those with incomparable results, were excluded.
After applying predefined selection criteria, titles and abstracts were first screened, followed by a full-text review and analysis of full articles. Any disagreement between the reviewers regarding the inclusion of studies in the systematic review was resolved in consultation with the specialist in the oral and maxillofacial surgery field.
The risk of bias (quality) assessment was also evaluated in included articles. The tool used for randomized trials: RoB 2 tool: A revised Cochrane risk of bias tool for randomized trials [18], a tool used for cohort studies: the Newcastle-Ottawa scale (NOS) [19].
Quality assessment
Systematic risk bias in randomized trials was determined based on the RoB 2 estimation algorithms. Considering the randomized sequences of the studies, deviation from the planned intervention, lack of outcome data, outcome assessment, and selective outcomes, the overall level of systematic risk of the randomized trials was determined (low, some concerns, or high).
Quality assessment of cohort studies was performed using the Newcastle-Ottawa scale, where the total maximum score is 9. Studies that scored ≥ 7 were considered high-quality. Bias was assessed by considering selection, comparability, and outcomes.
Results and Discussion
Study selection
The initial database search showed 6058 articles, an additional search through other sources added 9 more records. After applying the publication year filter (clinical studies published 2017-2022) and duplicates removed, 1153 records remained. Of these, 1132 did not meet the inclusion criteria. For full-text assessment, 21 articles were involved. Finally, 10 fulfilled all inclusion criteria and underwent qualitative data synthesis in this systematic review. Figure 1, demonstrates the PRISMA flow diagram.
|
Figure 1. PRISMA flow diagram. |
Study characteristics
In total, 10 studies were included in the systematic review. The main results are shown in Tables 1 and 2. Seven of included studies are randomized controlled clinical trials (RCT), and 3 are described as cohort studies. The number of patients in trials varied from 12 to 48 [20-29]. Six clinical trials [20, 24, 26-29] investigated flapless immediate implantation and 6 with flap elevation during implantation [21-23, 25-27]. Three studies investigated the maxillary anterior region [24, 25, 28], 5 studies analyzed the maxillary premolar region [20, 24-27], in 1 article, implantation sites were specified as maxillary and mandibular regions [22], and 1 publication described implantation site as premolar and molar region without jaws clarification [21], and 1 study described implantation site as a molar region [29].
In involved studies jump gap was filled with a blood clot, platelet concentrates (PRF and PRP), xenograft, or alloplastic graft [20-29]. The dimensional changes were evaluated in follow-ups from 3-12 months [20-29].
Table 1. General characteristics of the selected studies.
Author |
Type of study |
Material |
Patients |
Implants |
Site |
Evaluation |
Flap type |
Immediate restorations |
Elbrashy et al. [20] |
Randomized clinical trial (RCT) |
platelet rich fibrin (PRF) and xenograft |
20 |
Width 3.6–4.1 mm and length 10–14 mm |
Maxillary premolar region |
CBCT |
Flapless |
No |
Öncü & Erbeyoğlu [21] |
Cohort study |
L-PRF and no material |
30 |
Width 4.1 mm and length 12 mm |
Premolar and molar |
Intraoral radiographs |
Flap |
No |
Khan et al. [22] |
Cohort study |
PRF and no material |
17 (38 sites) |
- |
Maxillary and mandible |
Intraoral radiographs |
Flap |
No |
Khan et al. [23] |
Randomized clinical trial (RCT) |
PRP and no material |
12 |
- |
- |
CBCT |
Flap |
No |
Abdullah et al. [24] |
Randomized clinical trial (RCT) |
Xenograft |
23 |
- |
Maxillary anterior and premolar region |
CBCT |
Flapless |
Yes |
Paknejad et al.[25] |
Randomized clinical trial (RCT) |
Xenograft and no material |
20 |
Width 3.5-4.3 mm and length 12-14 mm |
Maxillary anterior and premolar region |
CBCT |
Flap |
Healing abutment (HA) |
Grassi FR et al. [26] |
Randomized clinical trial (RCT) |
Open flap with no material, open flap and xenograft and flapless with no material |
45 |
Width 4.1 mm and length 10-13.5 mm |
Maxillary premolar region |
CBCT |
Flap and flapless |
No |
Naji BM et al. [27] |
Randomized clinical trial (RCT) |
Open flap with no material, open flap and alloplastic graft and flapless with no material |
48 |
Width 3.7 mm and length 11.5-13 mm |
Maxillary premolar region |
CBCT |
Flap and flapless |
No |
Abd-Elrahman A et al. [28] |
Randomized clinical trial (RCT) |
No material |
- (20 (recipient sites) |
Width 3.3-3.7 mm and length 14-16 mm |
Maxillary esthetic zone |
CBCT |
Flapless |
Yes |
Chen et al. [29] |
Cohort study |
Xenograft |
15 |
Width 4.1-4.8 mm and length 8-12 mm |
Molar region |
CBCT |
Flapless |
Healing abutment (HA) |
Quality assessment
The risk of bias was assessed for all included studies. RoB 2 tool was used for randomized clinical trials and the Newcastle-Ottawa scale for cohort studies. Four of 7 randomized clinical trials were identified as low-risk, two as high-risk, and one as having some concerns. All 3 cohort studies show high methodological quality. The entire quality assessment process is graphically represented in Figure 2 and Table 2.
|
Figure 2. Quality assessment of randomized clinical trials (RoB 2 tool). |
Table 2. Quality assessment of cohort studies (NOS).
Study |
Selection |
Comparability (★★) |
Outcomes |
Total score (out of 9) |
|||||
Representativeness of the exposed cohort (★) |
Selection of the non- exposed cohort (★) |
Ascertainment of exposure (★) |
Outcome not present at the start of the study (★) |
Assessment of outcome (★) |
Length of follow-up (★) |
Adequacy of follow- up (★) |
|||
Oncu and Erbeyoglu [21] |
★ |
★ |
★ |
★ |
★★ |
|
★ |
★ |
8 |
Khan et al. [22] |
★ |
★ |
★ |
★ |
★★ |
★ |
★ |
|
8 |
Chen et al. [29] |
★ |
★ |
★ |
★ |
★ |
★ |
★ |
★ |
8 |
Autologous platelet concentrates
Four studies observed platelet concentrates usage on purpose to reduce bone resorption after immediate implantation [20-23]. Three studies evaluated platelet-rich fibrin (PRF) [20-22] and 1 platelet-rich plasma (PRP) [24] influence on the change in bone reduction. These studies were followed up for 3-12 months.
After 3 months, the change in vertical buccal bone reduction reached 0.71 mm in the mesial and 0.77 mm in the distal part after applying PRF in the immediate dental implantation procedure [22]. The use of PRP liquid during the immediate implantation procedure led to a vertical change in reduction that reached 0.03 ± 0.08 mm in the mesial and 0.07 ± 0.16 mm in the distal part after the same period [23].
After 4-6 months, the horizontal buccal bone reduction was 1.63 mm [20], and the reduction in vertical dimension was from 0.84 mm to 1.85 ± 0.89 mm [20, 22] in studies with PRF.
In one study investigating the PRP effect, vertical buccal bone resorption was 0.07 ± 0.10 mm in the mesial and 0.07 ± 0.16 mm in the distal part [23].
After 9-12 months, two studies observed changes in vertical bone resorption using PRF after immediate implant placement [21, 22]. Results varied from 0.7 ± 0.5 mm to 1.00 mm [21, 22].
Evaluating all analyzed autologous platelet concentrates studies, the greatest results (the lowest bone resorption) in vertical dimension after 3 and 4-6 months were reached with PRP, and after 9-12 months with PRF.
Xenograft
Five included studies assessed buccal bone resorption after immediate implantation with augmentation using xenograft [20, 24-26, 29]. These studies evaluated bone changes from 4 to 12 months [20, 24-26, 29].
After 4-6 months, the change in horizontal buccal bone reduction was from 0.4 ± 0.8 mm to 0.59 mm [20, 26, 29]. The resorption in the vertical dimension of the alveolar bone reached from 0.3 ± 0.7 mm to 1.30 ± 2.38 mm after the same period of follow-up [20, 25, 26, 29].
After 9-12 months, the use of xenograft during implant placement led to a horizontal change in buccal bone resorption that reached 0.34 mm ± 0.31 mm [24].
Alloplastic graft
One study included a grafting method with an alloplastic graft in immediate implantation [27]. The change in horizontal buccal bone reduction after 6 months was 0.37 ± 0.09 mm [27].
No grafting method
Seven studies observed immediate implantation without grafting material [21-23, 25-28]. Studies followed up from 3-12 months [21-23, 25-28].
After 3 months, the change in vertical buccal bone reduction varied from 0.07 ± 0.10 mm to 1.19 mm [22, 23].
After 4-6 months, the reduction in horizontal alveolar buccal bone varied from 0.24 ± 0.11 mm to 1.0 ± 1.1 mm in included studies [26-28]. The change in vertical alveolar buccal bone resorption ranged from 0.1 ± 0.6 mm to 2.14 ± 0.52 mm [22, 23, 25, 26, 28].
After 9-12 months, the vertical buccal bone reduction was from 1.3 ± 0.6 mm to 1.44 mm without grafting during immediate implantation [21, 22].
Table 3. Dimensional changes of buccal bone after immediate implantation.
Author |
Material |
Follow-up |
Horizontal buccal bone reduction |
P value |
Vertical buccal bone reduction |
P value |
Elbrashy et al. [20] |
Platelet rich fibrin (PRF) and xenograft |
6 months |
PRF group 1.63 mm; xenograft group |
P < 0.001 |
PRF group 1.85 ± 0.89 mm; xenograft group 0.77 ± 0.32 mm. |
P = 0.005 |
Oncu and Erbeyoglu [21] |
L-PRF and no material |
12 months |
- |
- |
L-PRF group 0.7 ± 0.5 mm; no material group 1.3 ± 0.6 mm. |
P ≤ 0.05 |
Khan et al. [22] |
PRF and no material |
3, 6, 9 months |
- |
- |
PRF group mesial part after 3 months- 0.71 mm, 6 months- 0.84 mm, 9 months 0.96 mm, distal part after 3 months- 0.77 mm, 6 months- 0.88 mm, 9 months 1.00 mm; no material group mesial part after 3 months- 1.08 mm, 6 months- 1.19 mm, 9 months 1.33 mm, distal part after 3 months- 1.19 mm, 6 months- 1.29 mm, 9 months 1.44 mm |
P < 0.001 |
Khan et al. [23] |
PRP and no material |
12, 26 weeks |
- |
- |
PRP group mesial part after 12 weeks 0.03 ± 0.08 mm, after 26 weeks- 0.07 ± 0.10 mm, distal part after 12 weeks 0.07 ± 0.16 mm, after 26 weeks- 0.07 ± 0.16 mm; no material group mesial part after 12 weeks 0.37 ± 0.80 mm, after 26 weeks- 0.43 ± 0.77 mm, distal part after 12 weeks 0.07 ± 0.10 mm, after 26 weeks- 0.17 ± 0.20 mm; |
P > 0.05 |
Abdullah et al. [24] |
Xenograft |
12 months |
0.34 ± 0.31 mm |
- |
- |
- |
Paknejad et al. [25] |
Xenograft and no material |
4-6 months |
- |
- |
Xenograft group 1,30 ± 2.38 mm; No material group 1,66 ± 2.67 mm |
P = 0.72 |
Grassi et al. [26] |
Open flap with no material, open flap and xenograft and flapless with no material |
6 months |
Open flap with no material group 1.1 ± 0.9 mm, open flap and xenograft group 0.4 ± 0.8 mm, and flapless with no material group 1.0 ± 1.1 mm; |
flap and xenograft versus flap no graft P = 0.03, others P > 0.05 |
Open flap with no material group 0.2 ± 0.6 mm, open flap and xenograft group 0.3 ± 0.7 mm, and flapless with no material group 0.1 ± 0.6 mm |
P > 0.05 |
Naji et al. [27] |
Open flap with no material, open flap and alloplastic graft and flapless with no material |
6 months |
Open flap with no material group 0.91± 0.54 mm, open flap and alloplastic graft group 0.37 ± 0.09 mm, and flapless with no material group 0.24 ± 0.11 mm; |
P < 0.003 0.016*Ivs II 0.744 I vs III 0.003* II vs III
|
|
- |
Abd-Elrahman et al. [28] |
No material |
6 months |
0.28 ± 0.15 mm |
- |
0.77 ± 0.35 mm |
- |
Chen et al. [29] |
Xenograft |
6 months |
0.48 ± 0.28 mm |
P < 0.01 |
0.74 ±0.32 mm |
P < 0.01 |
The main focus of the present study was to evaluate dimensional changes in buccal bone following immediate implantation during a 3 – 12 months period and to identify different grafting material's influence on buccal bone reduction. The best results in the vertical dimension of buccal bone reduction were obtained with the PRP material [23] after 3 months. After 4 – 6 months – the jump gap is filled with a natural blood clot in the horizontal plane [24] and PRP material in the vertical plane [23]. After 9 – 12 months, in the vertical dimension, the best results were achieved with PRF material [21]. According to the included studies, the lowest buccal bone loss was achieved with PRP, PRF, or without filling jump space with regenerative materials. It is important to mention the surgical procedure's methodology (tooth extraction, flap or flapless technique), the prosthetic protocol, the anatomical buccal bone features, jump space width, implant design, implantation site, and gingival biotype which may influence bone loss after immediate implantation. Thus, more systematically organized clinical trials are needed to draw firm conclusions.
Naji et al. [27] conducted a study comparing open flap with no material, open flap with alloplastic graft, and flapless with no material methods. The lowest bone loss was in the flapless without regenerative material group. Comparing the flapless with no material group and the open flap with no material group, buccal bone loss was greater in the open flap with no material group. Therefore, it can be concluded that the surgical method had a significant influence on the results. The flapless approach has been shown to have better results and is associated with better clinical outcomes, reduced healing time, and less discomfort and inflammation. The flapless technique does not separate the periosteum, therefore, preserves sufficient blood supply to the underlying buccal bone, which is associated with better clinical outcomes [30].
The dental implant design also affects bone changes after implantation. A comparative study by Patil et al. [31] revealed that using a micro-threaded rough collar design received statistically significantly less bone loss than using a smooth collar design (P < 0.05). Micro-threaded rough collar design was received by applying Sandblast Large grit Acid etch (SLA) [31]. Acid-etching protocol increases cell adhesion and bone formation. Consequently, osteoblasts growth is enhanced on SLA surfaces of implants and promotes greater osseointegration [32].
The jumping space width is one of the key factors for buccal bone changes after immediate implantation. A retrospective cone-beam computed tomography analysis demonstrated that the change in buccal bone horizontal dimension was statistically significantly thicker in the wide gap (> 2 mm) group than in the narrow gap (≤ 2 mm) group (1.9 ± 0.9 mm and 0.5 ± 0.6 mm, respectively). The grafting of more than 2 mm buccal gaps promoted a thicker buccal bone wall. It was suggested that the wider gap promotes more space for the bone graft, and the bone graft can reach the farthest point of the bone defect. Also, the implant is threaded further away from a buccal bone and reduces resorption [33]. Nonetheless, immediately placed implants with or without bone grafting have similar hard and soft tissue changes when the jumping distance is narrower than 2 mm [34].
As an alternative to regenerative materials, a collagen matrix could be used to fill the jumping gap. Jump space (3 – 4 mm) filled with collagen matrix causes marginal bone loss ranging from 0.28 ± 0.39 mm to 0.34 ± 0.48 mm [35]. Although comparative studies are lacking, this material may be promising in carefully selected cases.
Gingiva biotype also could affect the change of buccal bone reduction after implantation. In the study by Wallner et al. [36], there was no significant difference between gingival biotypes and bone loss (P > 0.05). The retrospective study by Sun et al. [37] noted that thick gingiva ensures less bone loss after implantation than thin gingiva. However, the impact of the gingiva biotype on bone change after implantation remains controversial.
Our main point was to evaluate the influence of different grafting materials on dimensional changes in buccal bone following immediate implantation. However, there is a lack of clinical studies independently evaluating several factors that may influence bone changes after immediate implantation.
Conclusion
In conclusion, the slightest buccal bone reduction after 3 months in vertical dimension was achieved using PRP material (the change of buccal bone reduction 0.03 ± 0.08 mm). After 4-6 months, the best results in horizontal dimension were shown by forming a natural blood clot in jumping space (0.1 ± 0.6 mm) and in vertical dimension by using PRP material (0.07 ± 0.10 mm). After 9-12 months, the lowest bone resorption in vertical buccal bone was reached using PRF grafting material (0.7 ± 0.5 mm).
Acknowledgments: None
Conflict of interest: None
Financial support: None
Ethics statement: None
1. Amaral Valladão CA Jr, Freitas Monteiro M, Joly JC. Guided bone regeneration in staged vertical and horizontal bone augmentation using platelet-rich fibrin associated with bone grafts: a retrospective clinical study. Int J Implant Dent. 2020;6(1):72. doi:10.1186/s40729-020-00266-y
2. Son NT, Ha HTT, Loi PV, Phong LH, Ha VT, Hoang PC, et al. Bone Marrow, Peripheral Blood and Plasma for Quantitation of BCR-ABL Transcript in Chronic Myeloid Leukemia. Pharmacophore. 2021;12(3):49-53.
3. Mostafavi Z, Houshyar J, Aliasgarzadeh A, Aghamohammadzadeh N, Sadra V, Khani M, et al. Comparison of the Bone Mineral Density between Acromegaly Patients and Healthy Individuals. Arch Pharm Pract. 2019;10(4):15-21.
4. Yamany IA. The Employment of CBCT in Assessing Bone Loss around Dental Implants in Patients Receiving Mandibular Implant Supported overdentures. Int J Pharm Res Allied Sci. 2019;8(3):9-16.
5. Bernstein S, Cooke J, Fotek P, Wang HL. Vertical bone augmentation: where are we now? Implant Dent. 2006;15(3):219-28. doi:10.1097/01.id.0000226824.39526.71
6. Tallgren A. The continuing reduction of the residual alveolar ridges in complete denture wearers: a mixed-longitudinal study covering 25 years. 1972. J Prosthet Dent. 2003;89(5):427-35.
7. Canullo L, Del Fabbro M, Khijmatgar S, Panda S, Ravidà A, Tommasato G, et al. Dimensional and histomorphometric evaluation of biomaterials used for alveolar ridge preservation: a systematic review and network meta-analysis. Clin Oral Investig. 2022;26(1):141-58. doi:10.1007/s00784-021-04248-1
8. Zaki J, Yusuf N, El-Khadem A, Scholten RJPM, Jenniskens K. Efficacy of bone-substitute materials use in immediate dental implant placement: A systematic review and meta-analysis. Clin Implant Dent Relat Res. 2021;23(4):506-19. doi:10.1111/cid.13014
9. Kan JYK, Rungcharassaeng K, Deflorian M, Weinstein T, Wang HL, Testori T. Immediate implant placement and provisionalization of maxillary anterior single implants. Periodontol 2000. 2018;77(1):197-212. doi:10.1111/prd.12212
10. Avila-Ortiz G, Chambrone L, Vignoletti F. Effect of alveolar ridge preservation interventions following tooth extraction: A systematic review and meta-analysis. J Clin Periodontol. 2019;46 Suppl 21:195-223. doi:10.1111/jcpe.13057
11. Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different bone grafts and bone-substitute materials. Int J Oral Maxillofac Implants. 2009;24 Suppl:218-36.
12. Fukuba S, Okada M, Nohara K, Iwata T. Alloplastic Bone Substitutes for Periodontal and Bone Regeneration in Dentistry: Current Status and Prospects. Materials (Basel). 2021;14(5):1096. doi:10.3390/ma14051096
13. Maia LP, Reino DM, Muglia VA, Almeida AL, Nanci A, Wazen RM, et al. Influence of periodontal tissue thickness on buccal plate remodelling on immediate implants with xenograft. J Clin Periodontol. 2015;42(6):590-8. doi:10.1111/jcpe.12405
14. Kobayashi E, Fujioka-Kobayashi M, Sculean A, Chappuis V, Buser D, Schaller B, et al. Effects of platelet-rich plasma (PRP) on human gingival fibroblast, osteoblast and periodontal ligament cell behaviour. BMC Oral Health. 2017;17(1):91. doi:10.1186/s12903-017-0381-6
15. Anitua E, Murias-Freijo A, Alkhraisat MH, Orive G. Clinical, radiographical, and histological outcomes of plasma rich in growth factors in extraction socket: a randomized controlled clinical trial. Clin Oral Investig. 2015;19(3):589-600. doi:10.1007/s00784-014-1278-2
16. Annunziata M, Guida L, Nastri L, Piccirillo A, Sommese L, Napoli C. The role of autologous platelet concentrates in alveolar socket preservation: A systematic review. Transfus Med Hemother. 2018;45(3):195-203. doi:10.1159/000488061
17. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
18. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. doi:10.1136/bmj.l4898
19. Luchini C, Veronese N, Nottegar A, Shin JI, Gentile G, Granziol U, et al. Assessing the quality of studies in meta-research: Review/guidelines on the most important quality assessment tools. Pharm Stat. 2021;20(1):185-95. doi:10.1002/pst.2068
20. Elbrashy A, Osman AH, Shawky M, Askar N, Atef M. Immediate implant placement with platelet rich fibrin as space filling material versus deproteinized bovine bone in maxillary premolars: A randomized clinical trial. Clin Implant Dent Relat Res. 2022;24(3):320-8. doi:10.1111/cid.13075
21. Öncü E, Erbeyoğlu AA. Enhancement of Immediate Implant Stability and Recovery Using Platelet-Rich Fibrin. Int J Periodontics Restorative Dent. 2019;39(2):e58-63. doi:10.11607/prd.2505
22. Khan ZA, Jhingran R, Bains VK, Madan R, Srivastava R, Rizvi I. Evaluation of peri-implant tissues around nanopore surface implants with or without platelet rich fibrin: a clinico-radiographic study. Biomed Mater. 2018;13(2):025002. doi:10.1088/1748-605X/aa8fa3
23. Khan AS, Zaheer N, Zaigham AM, Shahbaz M, Zaheer U, Alam MK. Effect of Platelet-Rich Plasma on Bone Healing in Immediate Implants Analyzed by Cone Beam Computerized Tomography: A Randomized Controlled Trial. Biomed Res Int. 2021;2021:6685991. doi:10.1155/2021/6685991
24. Abdullah AH, Abdel Gaber HK, Adel-Khattab D. Evaluation of soft tissue and labial plate of bone stability with immediate implant in direct contact versus gap with socket shield: A randomized clinical trial with 1 year follow-up. Clin Implant Dent Relat Res. 2022;24(5):548-58. doi:10.1111/cid.13117
25. Paknejad M, Akbari S, Aslroosta H, Panjnoush M, Hajheidary S. Effect of flapless immediate implantation and filling the buccal gap with xenograft material on the buccal bone level: A randomized clinical trial. J Dent (Tehran). 2017;14(6):344-51.
26. Grassi FR, Grassi R, Rapone B, Alemanno G, Balena A, Kalemaj Z. Dimensional changes of buccal bone plate in immediate implants inserted through open flap, open flap and bone grafting and flapless techniques: A cone-beam computed tomography randomized controlled clinical trial. Clin Oral Implants Res. 2019;30(12):1155-64. doi:10.1111/clr.13528
27. Naji BM, Abdelsameaa SS, Alqutaibi AY, Said Ahmed WM. Immediate dental implant placement with a horizontal gap more than two millimetres: a randomized clinical trial. Int J Oral Maxillofac Surg. 2021;50(5):683-90. doi:10.1016/j.ijom.2020.08.015
28. Abd-Elrahman A, Shaheen M, Askar N, Atef M. Socket shield technique vs conventional immediate implant placement with immediate temporization. Randomized clinical trial. Clin Implant Dent Relat Res. 2020;22(5):602-11. doi:10.1111/cid.12938
29. Chen Z, Li J, Wang HL, Yu H. Initial Bone Volume Changes After Immediate Implant Placement Associated with Filling the Gap Using Bovine Bone in Molar Sites. Int J Oral Maxillofac Implants. 2019;34(2):521-8. doi:10.11607/jomi.6750
30. Barone A, Toti P, Piattelli A, Iezzi G, Derchi G, Covani U. Extraction socket healing in humans after ridge preservation techniques: comparison between flapless and flapped procedures in a randomized clinical trial. J Periodontol. 2014;85(1):14-23. doi:10.1902/jop.2013.120711
31. Patil YB, Asopa SJ, Deepa D, Goel A, Jyoti D, Somayaji NS, et al. Influence of Implant Neck Design on Crestal Bone Loss: A Comparative Study. Niger J Surg. 2020;26(1):22-7. doi:10.4103/njs.NJS2819
32. Jemat A, Ghazali MJ, Razali M, Otsuka Y. Surface Modifications and Their Effects on Titanium Dental Implants. Biomed Res Int. 2015;2015:791725. doi:10.1155/2015/791725
33. Levine RA, Dias DR, Wang P, Araújo MG. Effect of the buccal gap width following immediate implant placement on the buccal bone wall: A retrospective cone-beam computed tomography analysis. Clin Implant Dent Relat Res. 2022;24(4):403-13. doi:10.1111/cid.13095
34. Kabi S, Kar R, Samal D, Deepak KC, Kar IB, Mishra N. Immediate dental implant placement with or without autogenous bone graft: A comparative study. Natl J Maxillofac Surg. 2020;11(1):46-52. doi:10.4103/njms.NJMS5919
35. Kadkhodazadeh M, Amid R, Moscowchi A, Khoshkam V. Clinical and radiographic evaluation of jumping distance management using a collagen matrix in flapless immediate implant placement. Dent Med Probl. 2021;58(2):173-8. doi:10.17219/dmp/130057
36. Wallner G, Rieder D, Wichmann MG, Heckmann SM. Peri-implant Bone Loss of Tissue-Level and Bone-Level Implants in the Esthetic Zone with Gingival Biotype Analysis. Int J Oral Maxillofac Implants. 2018;33(5):1119-25. doi:10.11607/jomi.6641
37. Sun P, Yu D, Luo X, Xu A, Feng Y, He FM. The Effect of Initial Biologic Width on Marginal Bone Loss: A Retrospective Study. Int J Oral Maxillofac Implants. 2022;37(1):190-8. doi:10.11607/jomi.9169